DESCRIPTION (provided by investigator): The perception of being at risk for cancer is an important prerequisite for cancer screening adherence, as indicated by empirical evidence and its central role in health behavior theories. Yet existent cancer risk perception measures entail one-item assessments of perceived illness probability, a strategy with known limits to reliability and validity. There are compelling arguments that affective (emotional, feeling-based) and intuitive cognitive (automatic, non-rational) processing is important as individuals'think about their personal cancer risk. We developed a questionnaire to measure affective and intuitive cognitive processing of personal cancer risk (Cancer Risk Beliefs Scale) encompassing five factors (Cognitive Causation, Negative Affect in Risk, Defensive Pessimism about Risk, Unpredictability of Cancer Risk, and Cancer Preventability). This current R21 application tests the construct and predictive validity of Cognitive Causation and Negative Affect in Risk in the context of colorectal cancer screening in 800 diverse, primary care patients ages 50 and over. We propose a prospective, observational study to examine the relationship of affective and intuitive cognitive processing of risk with colorectal cancer screening adherence. The primary hypothesis is that those high in affective and intuitive cognitive processing of risk will have an attenuated relationship between cancer risk perceptions and screening. This would provide a novel way to identify those for whom interventions to increase cancer risk appreciation may be less useful in motivating screening. We will characterize these individuals'beliefs with specificity that will be useful in developing alternative interventions for them. We propose;Aim I: to examine the prevalence and construct validity of cancer risk beliefs in a large, diverse primary care population, Aim II, to examine the relationship of affective and intuitive cognitive processing about cancer risk to colorectal cancer screening adherence, and Aim III, to examine the relationship of affective and intuitive cognitive processing about cancer risk to prospective uptake of colorectal cancer screening. The work proposed here draws on recent research on affect and cognitive processing of uncertainty to offer novel solutions to cancer screening non-adherence. PUBLIC HEALTH RELEVANCE: This work draws from recent decision-making research to offer novel solutions to cancer screening nonadherence. The study tests whether affective and intuitive cognitive processing of personal cancer risk, assessed through the newly-developed Cancer Risk Beliefs Scale, is related to colorectal cancer screening adherence in a diverse primary care population. These findings will provide a novel way to identify and intervene with those who are unresponsive to established perceived risk-enhancing screening interventions.